Session Type: Abstract Submissions (ACR)
Using combined data from the ATTEST  and AMPLE  study comparing infliximab and adalimumab with abatacept in patients with rheumatoid arthritis (RA), we sought to assess the relative effectiveness of infliximab, adalimumab, and abatacept in patients with RA and an inadequate response to methotrexate.
The meta-dataset included results from the ATTEST (NCT00095147) and AMPLE (NCT00929864) studies. Both trials included patients who met the American College of Rheumatology (ACR) criteria for RA, were at least 18 years of age, and had an inadequate response to MTX. Major outcomes concerned the benefits and harm after 1 year on therapy, American College of Rheumatology 50% (ACR50) criterion extracted from the papers and the number of withdrawals related to adverse events (AEs), respectively. All analyses were performed using the modified intention to treat population: all patients who were randomized and received at least one dose of study drug. Patients who discontinued the study prematurely were considered non-responders subsequent to the time of discontinuation. Statistical analyses were based on mixed-effects logistic regression using an arm-based, random-effects model respecting randomization within each study .
Compared with infliximab (IV), abatacept (IV/SC) and adalimumab SC were associated with a statistical significantly higher likelihood of achieving an ACR50 response (abatacept: OR 1.49, 95% CI: 1.03 to 2.15; P = .032; Adalimumab: OR 1.49, 95% CI: 1.02 to 2.19; P = .041). In contrast,the ACR50 responses for abatacept and adalimumab were comparable (OR 1.00, 95% CI: 0.75 to 1.32; P = .99). Abatacept was less likely than infliximab to result in discontinuation due to adverse events (OR 0.45, 95% CI: 0.21 to 0.96; P = .040) while infliximab and adalimumab were similar in this respect (OR 0.83, 95% CI: 0.39 to 1.74; P = .62)
The network analysis allowed indirect comparisons across all three groups. We conclude that infliximab, at the recommended dose, is less efficacious than either adalimumab or abatacept and that adalimumab and abatacept are approximately equivalent both in terms of benefit and short-term harm (up to 1 year).
 Schiff M, Ann Rheum Dis. 2008;67(8):1096-103.
 Weinblatt ME, Arthritis Rheum. 2013;65(1):28-38.
 Singh JA, CMAJ. 2009;181(11):787-96.
Abbott, Axellus A/S, Bristol-Myers Squibb, Cambridge Weight Plan, Norpharma, Pfizer, and Roche,
Axellus A/S, Cambridge Weight Plan, Mundipharma, and Roche,
Abbott, Axellus, Bayer HealthCare Pharmaceuticals, Biogen Idec, Bristol-Myers Squibb, Cambridge Weight Plan, Ipsen, Laboratoires Expanscience, MSD, Mundipharma, Norpharma, Pfizer, Roche, and Wyeth,
AbbVie, Actelion, Amgen, BMS, Gilead, GSK, NIH, Novartis, Pfizer, Roche/Genentech, UCB,
AbbVie, Actelion, Amgen, BMS, Janssen, Gilead, GSK, NIH, Novartis, Pfizer, Roche/Genentech, UCB,
AbbVie, Actelion, UCB ,
L. E. Kristensen,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-infliximab-or-adalimumab-vs-abatacept-in-patients-with-rheumatoid-arthritis-and-an-inadequate-response-to-methotrexate-attest-ample-network-randomized-trial/